title: European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013.
abstract: Advances in chronic myeloid leukemia treatment, particularly regarding tyrosine kinase inhibitors, mandate regular updating of concepts and management. A European LeukemiaNet expert panel reviewed prior and new studies to update recommendations made in 2009. We recommend as initial treatment imatinib, nilotinib, or dasatinib. Response is assessed with standardized real quantitative polymerase chain reaction and/or cytogenetics at 3, 6, and 12 months. BCR-ABL1 transcript levels ≤10% at 3 months, <1% at 6 months, and ≤0.1% from 12 months onward define optimal response, whereas >10% at 6 months and >1% from 12 months onward define failure, mandating a change in treatment. Similarly, partial cytogenetic response (PCyR) at 3 months and complete cytogenetic response (CCyR) from 6 months onward define optimal response, whereas no CyR (Philadelphia chromosome-positive [Ph+] >95%) at 3 months, less than PCyR at 6 months, and less than CCyR from 12 months onward define failure. Between optimal and failure, there is an intermediate warning zone requiring more frequent monitoring. Similar definitions are provided for response to second-line therapy. Specific recommendations are made for patients in the accelerated and blastic phases, and for allogeneic stem cell transplantation. Optimal responders should continue therapy indefinitely, with careful surveillance, or they can be enrolled in controlled studies of treatment discontinuation once a deeper molecular response is achieved.
authors.affiliation: Department of Hematology L. and A. Seràgnoli, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna, Italy. michele.baccarani@unibo.it
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Michael W
authors.initials: MW
authors.lastname: Deininger
authors.forename: Gianantonio
authors.initials: G
authors.lastname: Rosti
authors.forename: Andreas
authors.initials: A
authors.lastname: Hochhaus
authors.forename: Simona
authors.initials: S
authors.lastname: Soverini
authors.forename: Jane F
authors.initials: JF
authors.lastname: Apperley
authors.forename: Francisco
authors.initials: F
authors.lastname: Cervantes
authors.forename: Richard E
authors.initials: RE
authors.lastname: Clark
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Cortes
authors.forename: François
authors.initials: F
authors.lastname: Guilhot
authors.forename: Henrik
authors.initials: H
authors.lastname: Hjorth-Hansen
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hughes
authors.forename: Hagop M
authors.initials: HM
authors.lastname: Kantarjian
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Kim
authors.forename: Richard A
authors.initials: RA
authors.lastname: Larson
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lipton
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Mahon
authors.forename: Giovanni
authors.initials: G
authors.lastname: Martinelli
authors.forename: Jiri
authors.initials: J
authors.lastname: Mayer
authors.forename: Martin C
authors.initials: MC
authors.lastname: Müller
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pane
authors.forename: Jerald P
authors.initials: JP
authors.lastname: Radich
authors.forename: Philippe
authors.initials: P
authors.lastname: Rousselot
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Saglio
authors.forename: Susanne
authors.initials: S
authors.lastname: Saußele
authors.forename: Charles
authors.initials: C
authors.lastname: Schiffer
authors.forename: Richard
authors.initials: R
authors.lastname: Silver
authors.forename: Bengt
authors.initials: B
authors.lastname: Simonsson
authors.forename: Juan-Luis
authors.initials: JL
authors.lastname: Steegmann
authors.forename: John M
authors.initials: JM
authors.lastname: Goldman
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Hehlmann
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001549:Benzamides / Q000627:therapeutic use; D000069439:Dasatinib; D005060:Europe; D016044:Fusion Proteins, bcr-abl / Q000378:metabolism; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000628:therapy*; D010879:Piperazines / Q000627:therapeutic use; D011379:Prognosis; D011743:Pyrimidines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D033581:Stem Cell Transplantation; D013844:Thiazoles / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D013844:Thiazoles; D000068877:Imatinib Mesylate; D016044:Fusion Proteins, bcr-abl; C498826:nilotinib; D000069439:Dasatinib